Paraglottic and Pre-epiglottic Space Abscess in Adults: Report of Two Cases

Document Type : Case Report

Authors

Department of Otolaryngology, "Attikon" University Hospital, Athens, Greece. Rimini 1, Chaidari, Athens 124 62, Greece

Abstract

Introduction:
Acute epiglottitis or supraglottitis is a rapidly progressing upper respiratory tract infection that can often threaten the airway patency. Epiglottic abscess that expands to the paraglottic (PGS) or preepiglottic (PES) space and acute airway obstruction constitute rare complications, exclusively presented in adults.
 
Case Report:
We report two cases. In the first case flexible fiberoptic Rhino-Pharyngo-Laryngoscopy showed epiglottitis that was obstructing the airway and abscesses on the lingual surface of the epiglottis. Abscesses were opened using laser CO2. In the following days flexible fiberoptic endoscopy revealed persisting protrusion of the left hemilarynx. A CT scan was performed showing an abscess in the paraglottic space. Under direct laryngoscopy the abscess was drained. In the second case endoscopic examination revealed epiglottitis that did not cause airway obstruction. The patient was admitted for follow-up and treated with intravenous antibiotics. On the 5th day showed an exacerbation of her symptoms. A CT scan was performed that showed the existence of an abscess in the preepiglottic space. She was taken to surgery and the abscesses were drained through a cervical- U shaped- incission.
 
Conclusion:
Existance of an abscess means, by default, an adequate surgical treatment to ensure the airway, and immediate drainage under direct laryngoscopy or through an external approach.  Diagnosis is based exclusively on medical history and clinical examination.  CT scan is necessary to reveal “secret” abscesses and “silent” extension of the infection inside pre-epiglottic and paraglottic space even if epiglottitis is mild. Postoperative management includes proper care of the surgical wound and antibiotics.

Keywords

References

  1. Navaratnam AV, Smith ME, Majeed A, McFerran DJ. Adult supraglottitis: a potential airway emergency that can present in primary care. Br J Gen Pract. 2015; 65(631): 99-100.
  2. Baird SM, Marsh PA, Padiglione A, Trubiano J, Lyons B, Hays A, et al. Review of epiglottitis in the post Haemophilus influenzae type-b vaccine era. ANZ J Surg. 2018; 88(11): 1135-40.
  3. Westerhuis B, Bietz MG, Lindemann J. Acute epiglottitis in adults: an under-recognized and life-threatening condition. S D Med. 2013; 66(8): 309-11,13.
  4. Kenneth W, Altman M, PhD, Jamie A, Koufman M. Laryngopharyngeal Reflux and Laryngeal Infections and Manifestations of Systemic Diseases. In: James B, Snow J, Ashley Wackym P, (editors). Ballenger's Otorhinolaryngology: Head and Neck Surgery. 17th ed. Shelton, Connecticut: People’s Medical Publishing House; 2009: 885-99.
  5. Madhotra D, Fenton JE, Makura ZG, Charters P, Roland NJ. Airway intervention in adult supraglottitis. Ir J Med Sci. 2004; 173(4): 197-9.
  6. Bizaki AJ, Numminen J, Vasama JP, Laranne J, Rautiainen M. Acute supraglottitis in adults in Finland: review and analysis of 308 cases. Laryngoscope. 2011; 121(10): 2107-13.
  7. Berger G, Landau T, Berger S, Finkelstein Y, Bernheim J, Ophir D. The rising incidence of adult acute epiglottitis and epiglottic abscess. Am J Otolaryngol. 2003; 24(6): 374-83.
  8. Suzuki S, Yasunaga H, Matsui H, Fushimi K, Yamasoba T. Factors associated with severe epiglottitis in adults: Analysis of a Japanese inpatient database. Laryngoscope. 2015; 125(9): 2072-8.
  9. Tulunay OE. Laryngitis--diagnosis and management. Otolaryngol Clin North Am. 2008; 41(2): 437-51, ix.
  10. Hindy J, Novoa R, Slovik Y, Puterman M, Joshua BZ. Epiglottic abscess as a complication of acute epiglottitis.Am J Otolaryngol.2013;34(4):362-5.
  11. Dursun G, Keser R, Akturk T, Akiner MN, Demireller A, Sak SD. The significance of pre-epiglottic space invasion in supraglottic laryngeal carcinomas. Eur Arch Otorhinolaryngol. 1997; 254 Suppl 1: S110-2.
  12. Healy GB, Hyams VJ, Tucker GF, Jr. Paraglottic laryngitis in association with epiglottitis. Ann Otol Rhinol Laryngol. 1985; 94(6 Pt 1):618-21.
  13. Smith MM, Mukherji SK, Thompson JE, Castillo M. CT in adult supraglottitis. AJNR Am J Neuroradiol. 1996; 17(7): 1355-8.
  14. Ito K, Chitose H, Koganemaru M. Four cases of acute epiglottitis with a peritonsillar abscess. Auris Nasus Larynx. 2011; 38(2): 284-8.
  15. Boyce BJ, deSilva BW. Spontaneous MRSA postcricoid abscess: A case report and literature review. Laryngoscope. 2014; 124(11): 2583–5.
  16. Gillett D, Eynon-Lewis NJ. Supraglottitis and abscess formation. J Laryngol Otol. 2011; 125(1): 99-102.
  17. Lee YC, Kim TH, Eun YG. Routine computerised tomography in patients with acute supraglottitis for the diagnosis of epiglottic abscess: is it necessary?-a prospective, multicentre study. Clin Otolaryngol. 2013; 38(2): 142-7.

 

Iranian Journal of Otorhinolaryngology
Volume 32, Issue 3 - Serial Number 110
May and June 2020
Pages 187-191

Files

Share

How to cite

Statistics